[秘鲁利马国立癌症研究所胃癌患者胃切除及D2淋巴结清扫术后的辅助放化疗]

[Adjuvant chemo radiotherapy after gastrectomy and D2 lymphadenectomy in patients with gastric cancer in the National Institute of Cancer, Lima, Peru].

作者信息

Montenegro Paola, Flores Lourdes, Quintana Shirley, Casanova Luís, Ruíz Eloy, León Jorge, Mantilla Raúl

机构信息

Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú.

出版信息

Rev Gastroenterol Peru. 2013 Jan-Mar;33(1):34-8.

PMID:23539054

Abstract

INTRODUCTION

Adjuvant chemo radiotherapy is the standard treatment in Western countries in gastric cancer patients submitted to curative resection. INT0116 pivotal trial established adjuvant chemo radiation as the standard care for resected high risk adenocarcinoma of the stomach in US however was hampered by suboptimal surgery. There is controversial data about efficacy of this adjuvant therapy in patients who have undergone D2 lymphadenectomy predominantly. In our hospital D2 lymphadenectomy is standard surgery for gastric cancer.

OBJECTIVE

To prove that chemo and radio therapy post gastrectomy and D2 linphadenectomy in patients' with gastric cancer is effective.

MATERIAL AND METHODS

Retrospective study with gastric adenocarcinoma patients stage II to IV M0 who underwent curative resection at INEN (Instituto Nacional de Enfermedades Neoplasicas) Lima-Peru between 2001 and 2006. Standard treatment at institution is D2 lymphadenectomy. Chemo radiotherapy according to INT0116 was given like adjuvant therapy. Survivalcurves were calculated according to Kaplan-Meier method and compared with log-rank test.

RESULTS

84 patients were included 60.7% male and 39.3% female. Mean age was 49.5 years old. The pathologic stages were T1-T2 (15.5%), T3- T4 (84.5%), N0-N1 (10.7%), N2-N3 (89.3%). D2 lymphadenectomy was performed in all patients. The 3-year DFS was 17% and 3-year overall survival was 23.9%. However when we analyzed by subgroups the overall survival, was in group N1 (66.7%) and in group N2 (58.9%) and N3 (18.3%) and 3 years DFS by subgroups were N1 (100%), N2 (51.9%) and N3 (16.3%).

CONCLUSIONS

Adjuvant chemo radiotherapy decreased risk of death and relapse to three years mainly in patients with node positive N1-N2, who underwent curative resection with D2 lymphadenectomy, but recurrence was most frequent in N3 node positive, maybe is necessary improve the chemotherapy in this group of patients for decrease the rate of relapse.

摘要

引言

辅助放化疗是西方国家对接受根治性切除的胃癌患者的标准治疗方法。INT0116关键试验确立了辅助放化疗作为美国胃切除术后高危腺癌的标准治疗方案，然而该试验因手术不够理想而受到阻碍。对于主要接受D2淋巴结清扫术的患者，这种辅助治疗的疗效存在争议。在我们医院，D2淋巴结清扫术是胃癌的标准手术方式。

目的

证明胃癌患者胃切除术后及D2淋巴结清扫术后进行放化疗是有效的。

材料与方法

对2001年至2006年期间在秘鲁利马国家肿瘤研究所（INEN）接受根治性切除的II至IV期M0胃腺癌患者进行回顾性研究。该机构的标准治疗方法是D2淋巴结清扫术。按照INT0116方案给予辅助放化疗。采用Kaplan-Meier方法计算生存曲线，并通过对数秩检验进行比较。

结果

共纳入84例患者，男性占60.7%，女性占39.3%。平均年龄为49.5岁。病理分期为T1-T2（15.5%），T3-T4（84.5%），N0-N1（10.7%），N2-N3（89.3%）。所有患者均进行了D2淋巴结清扫术。3年无病生存率为17%，3年总生存率为23.9%。然而，当我们按亚组分析总生存率时，N1组为（66.7%），N2组为（58.9%），N3组为（18.3%）；按亚组分析3年无病生存率时，N1组为（100%），N2组为（51.9%），N3组为（16.3%）。